When a person has loose or watery stools, he has diarrhea. If mucus and blood can be seen in the stools, he has dysentery. Diarrhea can be mild or serious. It can be acute (Lasting for 3 to 7 day) or chronic (Lasting 3 weeks or more)
Diarrhoea disease make a heavy demand on health facilities and national health budgets in developing countries. Almost 30 percent of all persons seeking treatment are estimated to be suffering from a Diarrhoeal illness. Highest incidence is seen in children aged 6 months to 2 years which is commonly called the weaning period.
Diarrhoeal diseases are one of the major causes of childhood mortality and morbidity in developing countries. Where an estimated one thousand episodes occur each year in children under five. According to who, Diarrhoeal diseases caused more than 3 million deaths in 1995, 80 percent them being children under five of all the Diarrhoeal deaths, half are due to acute watery diarrhea, 35 percent due to persistent diarrhea and 15 percent due to dysentery. Primary cause of death in acute diarrhea is dehydration due to loss of fluids and electrolytes.
- Bacteria: E. coli, Vibrio cholerae, Salmonella, Shigella, Campylobactor Jejuni, yersinia enterocolitica, clostridium difficile, clostridium perfringes, S. Acres, Aeronmonas Hydrophile.
- Virus: Rota virus, Adeno virus, Norwalk virus, Corona virus, Astro virus, Entero virus.
- Parasites: Giardia Lamblia, Entamoeba Histolytica, Balantidium coli, Trichuris Trichura, crypto sporidium, Isospora, Stronglyloides stercoralis.
The most common cause of acute diarrhea in children, younger than 2 years of age is rotavirus.
In older children and adults, a possibility of vibrio cholerae infection should always be kept in mind.
- Age: Most common in children especially those between 6 months and 2 years. Incidence is highest in the age group 6-11 months, when weaning occurs.
- Immunity: Poor immune status predisposes t infection with agents leading to invasive diarrhea.
- Malnutrition: Repeated diarrhoeal episodes are a major cause of malnutrition and faltering weight gain. On the other hand, under nourished children suffer from long-lasting diarrhea and are at 15-20 times greater risk of dying as compared to a wellnourished child with diarrhoeal illness.
- Poverty, prematurity, reduced gastric acidity immunodeficiency, lack of personal and domestic hygiene and incorrect feeding practices are all contributory factors.
- Season: Diarrhoea tends to occur during summer and rainy seasons.
- Macro-Environment: Inadequate water supply, lack of sanitary facilities, poor personal and domestic hygiene, Improper food preparation and storage, poor weaning practices, early stopping of breast-feeding and practice of bottle-feeding.
Mode of transmission:
Infecting organisms usually spread by faeco-oral route either by contaminated food or water. Hands contaminated with faecal also spread infection directly. Files etc. may also spread organisms.
Incubation period: Varies, Depending on the causative organism.
Clinical features ( Symptoms ):
- Loose Motion: Initially watery (Diarrhoea) later n with mucus and/or blood (Dy sentry)
- Abdominal pain.
- Fever: Usually not present but may be of low grade.
- Stool examination: it may reveal.
- Trophozites indicating amoebiasis.
- Vibro cholerae is usually seen in hanging drop preparation.
- Giardia lamblia
- Stool culture for shigellosis.
- Correction of Dehydration.
- If no signs of Dehydration: Give ample of home available fluids (e.g. Rice and dal water, kanji, Buttermilk, Coconut water, Vegetable soups, Fruit juices along with water. Do not discontinue breast feeding but promote it. Teach the parents to watch for signs of dehydration. give the mother one ORS packet with instruction and demonstration about use. Prompt referral if required.
- Mild moderate dehydration: Use oral rehydration solution (ORS)
- Severe dehydration: Referral/ intravenous fluids
- Correction of electrolyte imbalance.
- Ampicillin, co-trimoxazole for bacillary dysentery.
- Tetracycline for V. Cholerae.
- Metronidazole/ Tinidazole for Giardiasis / Amoebiasis.
- Anti – Motility drugs like lomotil or loperamide be avoided.
For practical management of diarrhea, see appendix
Prevention and Control:
- Health promotion:
- Health Education about personal hygiene, sanitation and waste disposal, Prevention of fly breeding, food and water hygiene.
- For quality check on hotels and eating establishments.
- Licensing and Certification of vendors and food suppliers.
- Health check up of food handlers.
- Specific protection:
- Immuno-prophylaxis: Immunization is available against salmonella, Shigella, E-coli and certain virus, but not yet used for mass prophylaxis in out country.
- Early Diagnosis: Using the tests described above.
- Prompt and effective treatment: As outlined above and follow-up to avoid carrier states.
Has no role in this disease.
- Collect information about the case and immediately notify the health authorities.
- Health education of family, lay person’s food handlers, vendors about diarrhoeal disease, sanitation and waste disposal, prevention of fly breeding, food and water hygiene.
- Teaching the mother early recognition of severe dehydration and prompt referral.
- Promotion and continuation of breast feeding.
- Promotion of home fluids and oral rehydration therapy.
- Disinfection of water sources.